Achilles Rupture The Facts

Overview
Achilles tendon rupture is an injury that affects the back of your lower leg. It most commonly occurs in people playing recreational sports. The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear (rupture). The tendon can rupture completely or just partially. If you have an Achilles tendon rupture, you might feel a pop or snap, followed by an immediate sharp pain in the back of your ankle and lower leg that usually affects your ability to walk properly. Surgery is often the best treatment option to repair an Achilles tendon rupture. For many people, however, nonsurgical treatment works just as well.

Causes
The Achilles tendon is a strong bands of fibrous connective tissue that attaches the calf muscle to the heel bone. When the muscle contracts, the tendon transmits the power of this contraction to the heel bone, producing movement. The Achilles tendon ruptures because the load applied to it is greater than the tendon's ability to withstand that load. This usually occurs as a result of a sudden, quick movement where there is a forceful stretch of the tendon or a contraction of the muscles eg: jumping, sprinting, or pushing off to serve in tennis. This occurs most often in sports that require a lot of stopping and starting (acceleration-deceleration sports) such as tennis, basketball, netball and squash. The Achilles tendon is on average 15cm in length. Most ruptures occur 2-6cm above where the tendon inserts into the heel bone. This is the narrowest portion of the Achilles tendon and is also the area with the poorest blood supply. achilles tendon rupture is most common when the muscles and tendon have not been adequately stretched and warmed up prior to exercise, or when the muscles are fatigued. the Achilles tendon has a poor blood supply, which makes it susceptible to injury and slow to heal after injury. During exercise the amount of blood able to travel to the tendon is decreased, further increasing the risk of rupture. Most experts agree that there are no warning signs of an impending rupture. However, frequent episodes of Achilles tendonitis (tendon inflammation) can weaken the tendon and make it more susceptible to rupture.

Symptoms
You may notice the symptoms come on suddenly during a sporting activity or injury. You might hear a snap or feel a sudden sharp pain when the tendon is torn. The sharp pain usually settles quickly, although there may be some aching at the back of the lower leg. After the injury, the usual symptoms are as follows. A flat-footed type of walk. You can walk and bear weight, but cannot push off the ground properly on the side where the tendon is ruptured. Inability to stand on tiptoe. If the tendon is completely torn, you may feel a gap just above the back of the heel. However, if there is bruising then the swelling may disguise the gap. If you suspect an Achilles tendon rupture, it is best to see a doctor urgently, because the tendon heals better if treated sooner rather than later.

Diagnosis
Diagnosis is made mostly by clinical examination with a defect usually noted on visual examination and by touching the area. A simple test can be done by squeezing the back of the calf with the foot resting in the air. Normally when squeezing the muscle belly the tendon will shorten causing the foot to move in a downward position. With a rupture this squeezing effect may show no movement of the foot if it is not attached properly. A negative test does not mean there isn't some degree of rupture as some of the tendon fibers may still be attached. Sometimes x-rays, an mri, or an ultrasound can be helpful in determining the extent of the rupture.

Non Surgical Treatment
Non-surgical treatment of Achilles tendon rupture is usually reserved for patients who are relatively sedentary or may be at higher risk for complications with surgical intervention (due to other associated medical problems). This involves a period of immobilization, followed by range of motion and strengthening exercises; unfortunately, it is associated with a higher risk of re-rupture of the tendon, and possibly a less optimal functional outcome.

Surgical Treatment
There are two types of surgery to repair a ruptured Achilles tendon. In open surgery, the surgeon makes a single large incision in the back of the leg. In percutaneous surgery, the surgeon makes several small incisions rather than one large incision. In both types of surgery, the surgeon sews the tendon back together through the incision(s). Surgery may be delayed for about a week after the rupture, to let the swelling go down.

Prevention
The following can significantly reduce the risk of Achilles tendon rupture. Adequate stretching and warming up prior to exercising. If playing a seasonal sport, undertake preparatory exercises to build strength and endurance before the sporting season commences. Maintain a healthy body weight. This will reduce the load on the tendon and muscles. Use footwear appropriate for the sport or exercise being undertaken. Exercise within fitness limits and follow a sensible exercise programme. Increase exercise gradually and avoid unfamiliar strenuous exercise. Gradual ?warm down? after exercising.